Ask the Expert: Treatment on Inflammatory Arthritis

blog 11.12

In this week’s installment of Ask the Expert, Rheumatologist Dr. Theodore Fields discusses treatments for early inflammatory arthritis.

Q1. What are the common signs and symptoms of arthritis?

Hospital for Special Surgery’s Rheumatology Division is very interested in helping people recognize the early stages of an inflammatory arthritis, since we have special treatments for this kind of arthritis. When we say inflammatory arthritis, we are often discussing rheumatoid arthritis, but similar symptoms are present in psoriatic arthritis and Ankylosing Spondylitis. Inflammatory arthritis is different than mechanical arthritis. Mechanical arthritis is what we see when someone has an old joint injury, and then years later it gets stiff and painful. Mechanical arthritis also describes the osteoarthritis which is common as we age, where our fingers can develop bumps – especially in the joints closest to the fingernail. Inflammatory arthritis is different- and signs to look for include:

  1. Hand joint swelling that is not bony hard and has a little give to it and often involves the joints where the fingers meet the hand, or the middle joints of the fingers.
  2. Stiffness of the joints in the morning that lasts hour or more with mechanical arthritis the stiffness is generally much shorter.
  3. Feeling ill in your whole body, or a sense of fatigue, since inflammatory arthritis involves your body systemically, whereas mechanical arthritis is confined to the joints.

If you have any of these symptoms, see your internist or a rheumatologist. Review of your history, physical exam, lab tests and x-rays can help make a clear diagnosis.

Q2. Why is early treatment important?

Although inflammatory arthritis can cause much difficulty for people, our weapons for treating it have improved dramatically in the last 15 years. We have medications that not only can improve symptoms and let people be more active, but they also can slow or often stop progression of the disease itself. There is evidence that treating inflammatory arthritis early is more effective at preventing joint damage than later treatment (although later treatment still can be extremely helpful). For these reasons, it’s important to get evaluated if you have any clue to early inflammatory arthritis.

Q3. What is the effectiveness of heat and cold therapies?

Local treatments for joint pain, such as heat and cold applications, are definitely helpful, since they often reduce pain and permit joints to move better as part of an exercise program. For most people with chronic arthritis, it’s very helpful to be evaluated by a physical therapist (or occupational therapist if the upper extremity joints are the main issue) and develop an exercise program most appropriate for you. When indicated, physical and occupational therapists can use modalities such as ultrasound or wax baths, along with stretching, massage and education about joint protection which can help improve pain and function.

Q4. How important is finding a balance between rest and activity?

Rest versus activity becomes an important question for people with inflammatory arthritis, since fatigue is often a part of the illness. Fortunately, the medications available to the rheumatologist can very often dramatically help the fatigue. As long as fatigue is present, however, it’s important to strike the right balance. Sometimes, you will just need to get extra rest until your arthritis is under better control. During times of fatigue, it’s important to try and work in your exercise program, even if it needs to be modified. It can help to plan to exercise during the time of day that you find you have the most energy. For a discussion of fatigue in inflammatory arthritis, click here.

Q5. What is the patient’s role in treating or managing arthritis?

Managing arthritis is a partnership of the patient with a care team. People with arthritis that is bad enough to disrupt their daily activities work with their rheumatologist, physical therapist and/or occupational therapist, and may need splints made for inflamed joints. In the most severe cases, an orthopedic surgeon may be needed. A patient with arthritis needs to find a physician they are comfortable with, and work together in developing a plan they are willing to carry out. The person with arthritis needs to commit to a treatment plan and stick with it, and if it isn’t working they need to report back to the rheumatologist so a new plan can be developed. Along the way, the person with arthritis needs to be active in their guided exercise program, and to avoid specific activities that may further injure an inflamed joint. Hospital for Special Surgery recognizes the importance of patients fully understanding and helping to begin a treatment program, and we have patient education and support groups for people with rheumatoid arthritis of less than two years and a separate group for those with the condition for over two years.The goal of both these groups is to reduce patient stress, increase patient knowledge, and to encourage people with arthritis to ask questions and be active in helping determine their course of treatment.

Dr. Theodore P. Fields, Rheumatologist, specializes in the treatment of gout, rheumatoid arthritis, and osteoarthritis. Throughout his career, Dr. Fields has remained active in many professional organizations and has had his work recognized numerous times. Dr. Fields holds many professional appointments, including Director of the Rheumatology Faculty Practice Plan and Co-Chairman of the Hospital for Special Surgery Web Editorial Committee.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


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  1. Dr. Fields, I appreciate that you take into account the patient’s perspective. I live in Oregon and I’m having a hard time finding a hand specialist who will do pharyngeal joint aspiration. My PA-C tried to tell me that my deformed thumb was not caused from crocheting for years, and that the minor swelling in my right middle and ring finger was not caused from aggressively and quickly using a computer mouse to do intricate CAD design textile patterns. If my repetitive actions have nothing to do with my injuries, then my other thumb should also be deformed and my other fingers should also be swelled. My fathers thumb is deformed from working the same tool for 23 years, but he does not have RA. I suppose my bunions were not caused from wearing pointy shoes and infants whose heads were bound in ancient times do not have pointy heads? I’m trying to find a doctor on the west coast who can extract about 1/4 to a 1/2 of synovial fluid from my fingers. I am sensitive to OTC’s and Rx drugs. I’m not a guinea pig. I take herbs and supplements. I won’t manage my health with legal drug dealers. Thank you for your time and help.

    1. Hi Kristy, thank you for your inquiry. We reached out to Rheumatologist Dr. Theodore Fields and he has responded with the following: “I assume that you are interested in steroid injection in the phalangeal joints as well as aspiration. Fluid removal without injection usually leads to return of the fluid relatively soon. Sometimes we do take the fluid out without injection, for purposes of diagnosis, such as looking for crystals or infection. A rheumatologist or orthopedic hand surgeon would likely be the right types of specialists to discuss this with. Your local Arthritis Foundation chapter can likely give you some referrals, or you can look up a rheumatologist at the American College of Rheumatology website.”